Low Tech vs. High Tech

What is the difference between low tech and high tech in regards to Assistive Technology?

First, it is important to understand what is assistive technology to begin with.  To paraphrase many definitions that are available, assistive technology is the use of a device to assist with improving the function of the user.  For example, a pair of glasses can be considered assistive technology as they assist with vision.  A walker can be considered assistive technology as it helps with walking or ambulation.  There are also different levels of assistive technology, and this can be broken down into low and high tech devices.
 

Low technology does not require a power source.  Sometimes this can be the easiest and most practical of solutions in assistive technology.  Low tech devices are items that facilitate independence in an area as does high tech devices.  Examples of low tech are a cane for assistance with walking, a pencil grip for children with grasp issues, or even glasses to assist an individual with seeing their environment.  

Even if an individual can benefit from high tech assistive technology, it is always important that they have a low tech "backup".  Technology can fail, batteries die, and emergencies can happen.  In these cases, an individual will continue to meet their needs using their low tech device.  Also, low tech devices might be all a user needs.  High tech is not indicated for everyone.

Before we discuss high tech devices, there is another classification that many individuals use, mid tech.  The difference between mid tech  and low or high tech  is that mid tech has a battery source.  Typically, they have limited capability but do have a power source.  This can include communication devices that can be pre-programmed with single pre-saved phrases or simple remotes that can control an individual's lights.  

 Again, mid tech can also be an appropriate option for individuals.  They are simple devices that can facilitate independence for the user.

High Technology:

Users of high technology are typically individuals with significant functional impairments.  This can includes folks with spinal cord injuries, Lou Gehrig's disease, or muscular dystrophy.  Examples of high tech devices are:

• Communication devices with alternative access methods such as eye gaze
• Stand alone environmental control units, with alternative access, that can control multiple devices in the user's environment
• Computer workstations with alternative software and hardware for access, such as a head mouse or dwell click software 

These devices can assist a person with the most minimal of movement to independently communicate or control their computer.  

Funding can be a challenge for these devices and they can be quite costly.  Communication devices (or AAC devices) can often be partially covered by insurance companies.  A qualified professional can assist with the selecting the appropriate device for the user's needs and goals, as well as obtaining funding for best device choice.

What have your experiences with these forms of assistive technology?

Large Button Keyboards

Earlier, a blog post was done on mini keyboards.  It is also important to know about large button keyboards.  


Typically, mini keyboards are indicated for one handed users or individuals that good fine motor control but impaired gross motor control.  Conversely, large button keyboards are indicated for individuals with impaired fine motor, poor gross motor skills.  Users with poor fine motor require larger buttons since they need larger targets for increased accuracy.  

With both mini keyboards and large button keyboards alternative layouts can be obtained; either the standard QWERTY layout that is most commonly used or an ABC layout.  Depending on the keyboard, additional features can be obtained such as alternative colors or number of keys.

Something as simple as changing the size of the keyboard can facilitate independence for an person with impairments.  Individuals that would benefit from this type of change can vary but are not limited to individuals with Parkinson's disease, stroke survivors, Multiple Sclerosis, or Cerebral Palsy.  It is important to always evaluate all forms of technology, including various large button keyboards to make sure to find the best fit for the user for an adaptABLE world.

Switch Use

What is a switch?


Switches are used with all forms of assistive technology.  The easiest way to think about a switch is a device that can start or stop a device.  The most common type of switch is activate with some kind of touch, creating the contact of two surfaces or switches to work with an assistive technology device.

What kind of switches are there?


There are literally hundreds (if not thousands) of switches available for assistive technology access.  Switches are meant to be accessed by the available body part or motion that is strongest for the user.  This area of access needs to be consistent and not create fatigue with extended use.  The area of access can also vary dependent on the position of the individual.  For example, a person might use their finger for switch access when in their wheelchair and a sip and puff switch for when they are in their bed.


When evaluating what is the best switch site, it is recommended to evaluate distal to proximal.  This means, start with the hands or fingers.  If this is not an appropriate site, what can be done as we move up?  Are gross movements easier than fine movements?  If the individual cannot use their arms, what other areas are appropriate?  


Addition considerations for switch use is the amount of force required to press the switch (if it is a tactile switch).  When looking at the "specs" of the switch, you can find the amount of force in ounces or pounds for access.  This is very important for an individual with limited movement or a harder switch user that needs a more durable switch.

How can a switch be mounted for access?


There are many ways that a switch can be mounted.  Switches can be mounted to a wheelchair, tabletop, or any other surface for best access.  If appropriate, Velcro can be instrumental in attaching a switch for access.  


If additional mounting options are required, a simple tabletop mount might be appropriate.

Removable mounts can be used that would attach the switch to a wheelchair, tabletop, or any other surface.  These mounts can be purchased with varying arm lengths and plate sizes.

More permanent mounting can be done in wheelchair components such as in the headrest.  Conductive fabric and clothing can be used to create novel switches, making it a part of clothing.


What if the user cannot "hit" a switch?


There are switch options for an individual with limited or lack of movement that would be required in order to touch a switch.


Sip and puff:  A sip and puff switch is a great option for users with limited movement or issues with significant fatigue when attempting to touch a switch. Through the actions of sipping and puffing, the user can control their assistive 
technology device.

Proximity:  A proximity switch is activated when the user gets closer to the switch.  Dependent on the switch chosen, the range of how close the individual the user has to get to the switch to activate it can vary.  This switch can be mounted pointing at any area for the user.

EMG switch:  An EMG switch is also known as a muscle twitch switch.  A muscle twitch sensor is placed on a muscle that can be used consistently without pain or fatigue.  When the user contracts the muscle, it activates the assistive technology service. 


Sound switch:  This is a switch option that has been around for sometime.  The Clapper is an example of a sound switch.  When the individual makes a sound, it activates the device such as a communication device.  There are very sensitive sounds switches available allowing for changes in the sensitivity, how loud or soft the sounds needs for access.  


To conclude, the importance of switches and their positioning is very important. If the individual is not setup with the best switch for the strongest access site the user will not be efficient or conserve their energy.  Through a full evaluation, an appropriate recommendation can be made not only for the device but for the appropriate access method. 

Mini Keyboards

I often get asked about mini keyboards and one handed keyboards.  These keyboards are helpful for one handed users or individuals with good fine motor but impaired gross motor skills.


Often, I do not recommend one handed keyboards.  Although there are many options for one handed keyboards, I have yet to meet an individual that is very successful with this kind of keyboard.  The reason I find them difficult for training and use is that for an individual that was a typist prior to their injury or disability this is a new way to learn to type.  This is a "chording" form of typing, holding down multiple keys to get the letters that would have been on the other half of a conventional keyboard.

As for mini keyboards,they can be very helpful for your one handed user.  They have the standard QWERTY layout but since the keyboard is mini is decreases the amount of "travel" that the user requires for typing.  There are many types of mini keyboards.  Some are marketed to the disabled community, others are just "mini" keyboards, marketed to a more mainstream population.  It is important to trial various types and sizes to find the perfect fit.  


Typically, if a keyboard is for a disabled individual, it will be more costly.  The keyboard below is $585.00, marketed towards individuals with disabilities.

There are also keyboards that are mini but marketed towards gamers.  This keyboard below I love because it can be used with thumbs only (similar to a blackberry keyboard) and has a mouse mover as well.  I have used this keyboard with individuals with varying disabilities.  It has facilitated independence in all of the appropriate folks I have worked with.  Since this is not for disabled individuals, it can be found online for $119.00

Even "childsize" keyboards can work as a mini keyboard.  This one below can be found for $62.00 plus shipping online.   

It is always important to remember that not all keyboards fit everyone.  Whenever evaluating keyboards for an adaptABLE world, all options must be tried for success.